title: Impact of different types of resuscitation fluids on coagulation and continuous venovenous hemofiltration hemocompatibility in a porcine model.
abstract: Intensive therapy demanding diseases (organ failure or sepsis) are assumed to be the etiology behind a decreased biocompatibility of extracorporeal systems for renal replacement therapy (RRT). There are also potential interactions between different components of the overall therapy. Volume substitutes are known to influence hemorheology and coagulation. To define a potential net effect of volume substitutes on the hemocompatibility of an RRT, we chose an animal model without interfering pathophysiologies. According to the problem of early filter failure and coagulation disorders in critically ill patients, we focused on the hypothesized interaction between RRT and different volume substitutes with respect to blood cell counts, coagulation parameters and required heparin dose. Forty-eight pigs were assigned to four groups of fluid therapy with either normal saline (NaCl), 6%HES130kD/0.4 (HES130), 6%HES200kD/0.5 (HES200) or 4%gelatin (GEL). Six pigs of each fluid group underwent continuous venovenous hemofiltration (CVVH), the remaining six served as the control group. Anticoagulation was performed with continuous heparin infusion. CVVH was run in a recirculation-mode for 4.5 h to force hemocompatibility reactions, thereafter in a standard-mode for 2 h. During the CVVH-treatment GEL reduced platelet counts and fibrinogen concentration and additionally lowered ATIII levels. Heparin requirements did not differ between different volume substitutes or CVVH and control groups. Severe pathophysiologies are not the only reason for a reduced hemocompatibility of CVVH treatment. Interaction of a particular volume substitute with CVVH should be considered when interpreting study results and evolving new strategies.
authors.affiliation: Department of Experimental Medicine (FEM), Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Janis Rebecca
authors.initials: JR
authors.lastname: Bedarf
authors.forename: Sascha
authors.initials: S
authors.lastname: Grosch-Ott
authors.forename: Martin
authors.initials: M
authors.lastname: Russ
authors.forename: Johanna Josophina
authors.initials: JJ
authors.lastname: Wagner
authors.forename: Bernhard
authors.initials: B
authors.lastname: Hiebl
authors.forename: Michael
authors.initials: M
authors.lastname: Kirschfink
authors.forename: Juliane Katharina
authors.initials: JK
authors.lastname: Unger
mesh_terms: D000818:Animals; D000925:Anticoagulants / Q000008:administration & dosage; D001777:Blood Coagulation; D004195:Disease Models, Animal; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D005440:Fluid Therapy / Q000379:methods*; D005780:Gelatin / Q000008:administration & dosage; D006440:Hemofiltration / Q000379:methods*; D006493:Heparin / Q000008:administration & dosage; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage; D010976:Platelet Count; D015532:Rehydration Solutions / Q000008:administration & dosage*; D012151:Resuscitation / Q000379:methods*; D013552:Swine
chemical_list: D000925:Anticoagulants; D006895:Hydroxyethyl Starch Derivatives; D015532:Rehydration Solutions; D005780:Gelatin; D005340:Fibrinogen; D006493:Heparin
keywords: Anticoagulation; Coagulation; Colloids; Continuous venovenous hemofiltration; Hemofiltration; Renal replacement